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研究生:江孫昭萍
研究生(外文):CHIANG SUN,CHAO-PING
論文名稱:血液透析病人血清白蛋白變化對其存活影響之探討
論文名稱(外文):Effect of alteration of serum albumin on survival in hemodialysis patients
指導教授:陳楚杰教授
指導教授(外文):CHEN,CHU-CHIEN
口試委員:陳楚杰李佩珍賴台軒
口試委員(外文):CHEN,CHU-CHIENLEE, PEI-CHENLAI,TAI-SHUAN
口試日期:2021-06-25
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:健康事業管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:中文
論文頁數:66
中文關鍵詞:血液透析營養不良血清白蛋白存活
外文關鍵詞:hemodialysismalnutritionserum albuminsurvival
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背景:臺灣透析發生率及盛行率高居不下,透析人數每年以3-4%成長。血清白蛋白的檢驗值代表透析病人營養狀態之指標,而血清白蛋白是慢性透析病人死亡的強烈預測因子,因此本研究探討血液透析病人血清白蛋白對血液透析病人存活之影響,並找出何者為存活重要的影響因子。
目的:本研究旨在探討利用台灣腎臟醫學會慢性腎臟病整合作業規畫管理系統TSN-KiDit 2008年1月1日至2016年12月31日檢驗數據資料庫,探討血液透析病人血清白蛋白變化對血液透析病人存活之影響。
方法:本研究設計為回溯性世代研究,收案期間為2008年1月1日至2016年12月31日,收案對象為北部某地區醫院接受血液透析且血液透析三個月(含)以上之血液透析病人,使用台灣腎臟醫學會慢性腎臟病整合作業規畫管理系統TSN-KiDit檢驗數據資料庫,利用SAS9.4統計套裝軟體進行資料處理及統計分析,進行基本人口學特徵、電子病歷查閱,共收得有效樣本205位,進行描述性統計、卡方檢定、log rank檢定及Cox比例風險模型(Cox proportional hazards model),統計檢定以P<0.05為達到統計上的顯著水準,探討血液透析病人血清白蛋白對血液透析病人存活之現況。
結果:病人年齡分布範圍為22-94歲,平均年齡為67.18±13.84歲,其中男性有114位(55.6%)、女性有91位(44.4%),平均院外透析時間為6.18±4.39年,死亡率50.7%,且透析病人若於透析追蹤時間伴隨低血清白蛋白(<3.5 mg/dL)之狀況死亡率則高於50%。本研究之透析病人一年存活率為90.7%、三年存活率為77.1%,進一步分析發現若於透析追蹤時間伴隨持續低血清白蛋白之症狀一年存活率下降至50%,但若持續維持血清白蛋白較佳狀態存活率可達95%。在控制基本人口學及慢性疾病下,分析發現透析追蹤時間伴隨低血清白蛋白之症狀,將顯著提高死亡風險(血清白蛋白變不好 HR:2.71; 95%CI: 1.67-4.39; p<0.001、血清白蛋白持續不好HR:4.33; 95%CI:2.32-8.07; p<0.001)。本研究另發現除年齡上升會提高死亡風險(HR:1.04; 95%CI:1.02-1.05; p<0.001)以外,透析病人合併糖尿病亦會顯著提升病人之死亡風險(HR:2.31; 95%CI:1.45-3.70; p=0.001)。
結論:本研究結果顯示,初次進入血液透析之族群有16.6%伴隨低血清白蛋白之症狀,透析追蹤時間若伴隨低血清白蛋白之症狀更顯著提升死亡之風險,且若合併糖尿病之慢性疾病亦會提高死亡之風險。因此,建議臨床醫護透析專業人員對於血液透析病人合併血清白蛋白異常者,可加強衛教指導,管控血清白蛋白,以提升血液透析病人之平均餘命。

Background: The incidence and prevalence of dialysis in Taiwan remain high, and the number of dialysis patients is growing by 3-4% every year. The test value of serum albumin represents an indicator of the nutritional status of dialysis patients. Therefore, this study explores the effect of serum albumin in hemodialysis patients on the survival of hemodialysis patients, and finds out which is an important factor for survival, in order to help patients get the best health status.
Objectives: The purpose of this study was to explore the effect of serum albumin changes on the survival of hemodialysis patients by using TSN kidit, from January 1, 2008 to December 31, 2016..
Methods: This study is a retrospective cohort study. The enrollment period was from January 1, 2008 to December 31, 2016. The subjects enrolled were patients receiving outpatient hemodialysis in a district hospital in Taipei. The laboratory data were extracted from the TSN-KiDit database of Taiwan Society of Nephrology. The results were analyzed with SAS 9.4, a statistical software package for data processing and statistical analysis. We organized basic demographic characteristics and reviewed electronic medical record, a total of 205 valid samples had been collected. Then descriptive statistics, chi-square test, log rank test and COX regression analysis(Cox proportional hazards model) were performed, the statistical test takes P < 0.05 as the statistically significant level. The purpose is to explore the current status of hemodialysis patients' serum albumin on the survival of hemodialysis patients, and find out which is the most important factor for survival.
Results: The age distribution range of the patients was 22-94 years old, with an average age of 67.18±13.84 years, of which 114 were males (55.6%) and 91 were females (44.4%). The average dialysis time was 6.18±4.39 years and the mortality rate was 50.7%. And if dialysis patients are accompanied by low serum albumin (<3.5 mg/dL) during dialysis, the mortality rate is higher than 50%. In this study, the one-year survival rate of dialysis patients was 90.7% and the three-year survival rate was 77.1%. Further analysis revealed that if the symptoms of persistent low serum albumin during dialysis are accompanied by symptoms, the one-year survival rate drops to 50%, but if the serum is maintained continuously The survival rate of albumin in a better state can reach 95%. Under the control of basic demographics and chronic diseases, analysis found that symptoms of low serum albumin during hemodialysis will significantly increase the risk of death (serum albumin deterioration HR: 2.71; 95% CI: 1.67-4.39; p<0.001 , Serum albumin persists poorly (HR: 4.33; 95% CI: 2.32-8.07; p<0.001). This study also found that in addition to rising age can increase the risk of death (HR: 1.04; 95%CI: 1.02-1.05; p<0.001), diabetes patients on dialysis also significantly increase the risk of death (HR: 2.31; 95% CI :1.45-3.70; p=0.001).
Conclusions: The results of this study show that 16.6% of people entering hemodialysis for the first time have symptoms of low serum albumin. During dialysis, symptoms of low serum albumin will significantly increase the risk of death, and chronic diseases with diabetes will also increase death. The risk. Therefore, it is recommended that clinical medical dialysis professionals for hemodialysis patients with abnormal serum albumin can strengthen the guidance of health education and control serum albumin to improve the average survival of hemodialysis patients.

致謝 I
中文摘要Ⅱ
Abstract IIV
目錄 VII
表目錄 VIII
圖目錄 IX
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 4
第三節 研究重要性 5
第二章 文獻探討 6
第一節 末期腎臟疾病與血液透析 6
第二節 血清白蛋白之定義 13
第三節 血清白蛋白變化對血液透析病人存活之影響 15
第三章 研究方法 18
第一節 研究架構 19
第二節 研究對象 20
第三節 資料來源與研究審查 22
第四節 研究變項及其操作型定義 23
第四章 研究結果 27
第一節 研究對象基本人口學特性、透析狀態及合併症 27
第二節 以Cox比例風險模型(Cox proportional hazards model)分析探討影響透析病人死亡
之危險因子 31
第三節 血清白蛋白變化對於存活之影響 35
第五章 討論與建議 39
第一節 研究結果與討論 39
第二節 研究限制 43
第三節 研究建議 43
參考文獻 45
中文文獻 45
英文文獻 47
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